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Emergency care is a concept almost everyone is familiar with. All sorts of things, from sprained ankles to lacerations, can cause a trip to the ER. In recent years, with the advent of so many urgent care centers, there has been a new and more wallet-friendly option: urgent care.
On Medicare, emergency care and urgent care both fall under Part B – Outpatient Care, for which the patient is responsible for 20% of the cost.
For people with Medigap coverage, such as a Plan F, the financial end result is the same. Medicare covers its 80% portion, and your Medigap plan generally covers the rest. Pretty simple.
However, with nearly 30% of Medicare enrollees now choosing Medicare Advantage plans, it is important to understand the difference so you can take advantage of savings in many circumstances.
At our agency, we explain it like this:
Visit an ER for severe or life-threatening emergencies.
Emergency Care is for life-threatening injuries or illnesses that put you in serious danger. If something has happened to you that could cause great bodily harm or even be fatal, a trip to an ER is necessary. Medicare Advantage plans often have HMO or PPO networks, and if there is a network hospital near you during an emergency, that’s great. However, if you face this situation, you are to proceed to the nearest hospital even if you are out of town and there is no hospital available in your network.
One great thing about many Medicare Advantage plans is that they provide Worldwide emergency care and urgent care. When you are truly sick or injured, the insurance company does not want you thinking about networks. Put yourself first and obtain the care you need from the nearest hospital.
Urgent care, on the other hand, is for less threatening injuries. Say it’s Saturday night, and you cut yourself while preparing dinner. If the cut is deep and you need stitches, a visit to an urgent care clinic is likely to provide the care you need at a lower copay than an ER visit. More importantly, a visit to an urgent care clinic will often take less time because these clinics are not dealing with the more life-threatening types of injuries that a hospital does.
X-rays are available on-site at Urgent Care clinics.
Many urgent care centers accept Medicare readily, and new locations are opening in major cities all the time. You have probably seen local urgent care centers in your town or the town nearest to you. In Fort Worth, we have several Urgent Care clinic chains like Care Now and Concentra Medical Centers. Often these clinics are open until late at night and on Saturdays. Some clinics even have 24-hour and Sunday hours.
Urgent care clinics are staffed by medical doctors, physician’s assistants, and nurses, just like any doctor’s office. A wide range of services and diagnostic tests are available. What’s great is that they can help with minor bumps and bruises and things like migraines, sinusitis, urinary tract infections, and all sorts of other ailments.
So next time you find yourself with an emergency, consider whether it is minor enough to visit just an urgent care clinic instead of spending long hours waiting in an emergency room. It’s a great alternative and can help reduce some of your out-of-pocket costs.
